Hepatology is a branch of medicine concerned with the study, prevention, diagnosis and management of diseases that affect the liver, gallbladder, biliary tree and pancreas.

GALLSTONES

Gallstone is defined as the hardened deposits that can form in the digestive fluid of the gallbladder. Gallbladder is a small, pear-shaped organ on the right side of abdomen, just beneath the liver. Digestive fluid which is called bile is hold in the gallbladder and released into the small intestine.

Gallstones size ranges from as small as a grain of sand to as large as a golf ball. In some people just one gallstone develops while in others may develop many gallstones at the same time.

Sometimes the people who experience symptoms from gallstones which usually require gallbladder removal surgery. Gallstones can cause any signs and symptoms but typically they don't need treatment.

Gallstones sometimes may not cause any signs or symptoms. If a gallstone stick in a duct and causes a blockage to fluids and results into signs and symptoms may include:

• Sudden and rapidly intensifying pain in the upper right portion of abdomen
• Sudden and rapidly intensifying pain in the center of abdomen, just below breastbone
• Back pain between the shoulder blades
• Pain in right shouldera
• Nausea or vomiting

Immediate care is needed if the patient develops signs and symptoms of a serious gallstone complication, such as:

• Severe Abdominal pain
• Yellowing of skin and the whites of your eyes (jaundice)
• High fever with chills

Gallstones usually form when:

• The bile contains too much cholesterol. Normally, bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But in case if liver excretes more cholesterol than bile can dissolve in the fluids and excess of cholesterol may also form crystal/stones.
• The bile contains too much bilirubin. Various conditions can also cause liver to make excess amount of bilirubin and include liver cirrhosis, biliary tract infections and may also result into certain blood disorders. The excess bilirubin contributes to gallstone formation.
• The gallbladder doesn't empty correctly.

Gallstones can be of various types:

• Cholesterol gallstones
• Pigment gallstones

Factors may increase the risk of gallstones which include:

• Being female
• Being age 40 or older
• Being overweight or obese
• Being sedentary
• Being pregnant
• Eating a high-fat diet
• Eating a high-cholesterol diet
• Eating a low-fiber diet
• Having a family history of gallstones
• Having diabetes
• Having certain blood disorders like sickle cell anemia or leukemia
• Losing weight very quickly
• Having liver disease
• Taking medications that contain estrogen like contraceptives or hormone therapy drugs

Complications of gallstones may include:

A liver transplant is a procedure that removes a liver surgically if there is any case of liver failure and replaces it with a healthy liver from a deceased donor or a part of a healthy liver of a living donor.

Liver is the largest internal organ and performs many critical functions which includes:

• Processing nutrients, medications and hormones
• Produce bile that helps the body absorb cholesterol, fat and fat-soluble vitamins
• Making proteins that help the blood clot
• Removing bacteria and toxins from the blood
• Preventing infection and regulating immune responses

Liver transplant is usually a treatment option for the patients who have significant complications and are in the end-stage of chronic liver disease. Liver transplant may also a treatment option for the sudden failure of a healthy liver.

For a deceased-donor liver the living-donor liver transplant is an alternative to become available. Liver transplant is possible because the human liver regenerates and returns to its normal size in a very short time after surgical removal of part of the organ.

Types

• Living-donor liver transplant

Liver transplant is a very useful treatment option for the patients with liver failure whose condition can't be controlled with other treatments other than surgery/transplant and for some people with liver cancer.

Liver failure may affect a human very quickly or over a long period of time. Liver failure which occurs quickly in some weeks, is called acute liver failure. Acute liver failure is a condition which is very uncommon and usually the results in complications from certain medications.

Although an acute liver failure may treat with liver transplant, it is more often used to treat chronic liver failure. Chronic liver failure takes time and occur slowly over months and years.

Chronic liver failure can be caused different type of conditions. Liver cirrhosis is the most common cause of chronic liver failure. When scarring/cirrhosis occurs, normal liver tissue replaced by scar tissues and causes the liver to not function properly. Cirrhosis or scarring of the liver is the most frequent reason for a liver transplant.

Major causes of the scarring of the liver leads to liver failure and liver transplant and include:

• Hepatitis B and C.
• Liver disease due to alcohol, this can cause damage to the liver due to excessive alcohol consumption.
• Nonalcoholic fatty liver disease is also a condition in which fat builds up in the liver and cause swelling/inflammation to liver cells or liver cell damage.
• Genetic diseases affecting the liver, including hemochromatosis, which causes excessive iron buildup in the liver and Wilson's disease, which causes excessive copper buildup in the liver.
• Diseases which affect the bile ducts can cause primary biliary cirrhosis, primary sclerosing cholangitis and biliary atresia. Biliary atresia is also the most common reason among children is liver transplant.

Liver transplant may also treat certain cancers that originate in the liver.

Complications of the procedure

Liver transplant surgery can cause many risks and significant complications. There are many risks that are associated with the surgery/procedure as well as with the drugs which are necessary to prevent liver rejection of the donor liver after the transplant.

Risks associated with the procedure include:

• Bile duct complications which includes bile duct leaks or shrinking of the bile ducts
• Bleeding
• Blood clots
• Failure of donated liver
• Infection
• Rejection of donated liver
• Mental confusion or seizures